Impact of dental sedation treatment on the oral health-related quality of life of distressed young children: A secondary analysis of a randomized clinical trial.

INTRODUCTION: Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL). AIM: To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families. METHODS: Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated. RESULTS: Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably. CONCLUSION: Dental treatment under sedation significantly improved the OHRQoL of the children and their families.

Como avaliar a dor sentida por crianças pré-escolares durante os procedimentos odontológicos? revisão de escopo / How to evaluate the pain felt by preschool children during dental procedures? scope review

Introdução: o diagnóstico da dor sentida pela criança é um passo importante para orientar o cirurgião-dentista sobre o uso de técnicas farmacológicas e não farmacológicas que minimizem a sensação desagradável. Objetivo: identificar os instrumentos usados para a avaliação da dor de crianças pré-escolares durante procedimentos odontológicos. Fontes dos dados: busca por artigos foi realizada no PubMed, Scopus, The Cochrane Library e Google Schoolar, em abril/2022. Estudos observacionais e de intervenção que avaliaram a dor de crianças pré- escolares em atendimento odontológico, publicados em português, inglês ou espanhol foram incluídos. Estudos que avaliaram a dor de crianças tratadas sob sedação ou anestesia geral, bem como a dor pós-operatória, foram excluídos. Síntese dos dados: um total de 767 artigos foram identificados; 133 artigos foram lidos integralmente e 62 incluídos. Em 48 estudos, a dor foi avaliada por meio de autorrelato, usando instrumentos como a Wong-Baker FACES Pain Rating Scale e outras escalas de faces como a Faces Pain Scale-Revised e a Faces Pain Scale. Quando a dor foi avaliada a partir do comportamento infantil, foram usadas escalas como a Face, Legs, Activity, Cry, Consolability Scale (FLACC) e a Sound, Eye and Motor scale (SEM). Conclusão: a dor processual das crianças foi avaliada por meio de autorrelato e da observação do seu comportamento. Tanto as escalas de autorrelato quanto as observacionais têm limitações. A combinação dos instrumentos pode ser uma estratégia na avaliação da dor de pré-escolares.

Introduction: the diagnosis of the pain felt by the child is an important step to guide the dentist on the use of pharmacological and non-pharmacological techniques that minimize unpleasant sensation. Objective: to identify the instruments used to assess the pain of preschool children during dental procedures. Sources of Data: search for articles was conducted at PubMed, Scopus, The Cochrane Library and Google Schoolar in April/2022. Observational and interventional studies that evaluated the pain of preschool children in dental care, published in Portuguese, English or Spanish were included. Studies evaluating the pain of children treated under sedation or general anesthesia, as well as postoperative pain, were excluded. Synthesis of data: a total of 767 articles were identified; 133 articles were read in full and 62 included. In 48 studies, pain was evaluated by self-report, using instruments such as the Wong-Baker FACES Pain Rating Scale and other face scales such as the Faces Pain Scale-Revised and the Faces Pain Scale. When pain was evaluated from child behavior, scales such as Face, Legs, Activity, Cry, Consolability Scale (FLACC) and Sound, Eye and Motor scale (SEM) were used. Conclusion: the procedural pain of the children was evaluated by self-report and the observation of their behavior. Both self-report and observational scales have limitations. The combination of the instruments can be a strategy in the evaluation of the pain of preschoolers.

Minimal intervention procedures: evaluating how much pediatric dentists really know about this field.

The aim of this cross-sectional study was to evaluate how much pediatric dentists know about the noninvasive, micro, and minimally invasive strategies for managing caries lesions in deciduous teeth. An electronic questionnaire was sent to pediatric dentists enrolled in the Regional Board of Dentistry. Information was collected concerning: 1) characteristics of the participants; 2) level of updated knowledge of noninvasive, micro and minimally invasive procedures for caries management in children; 3) agreement to sentences on the indicated procedures. The data were analyzed descriptively and with bivariate tests. Seventy pediatric dentists participated. Results showed high frequency of agreement with sentences on strategies for lesion caries management: 92.8% with the sentence on selective removal of decayed tissue; 90.0% on fluoridated toothpaste (≥1,000 ppm); 84.3% on silver diamine fluoride (SDF); 80.0% on the Hall technique; and 76.9% on the sealing of small dentine lesions. Level of agreement with sentences was not significantly related to variables of time since graduation, degree of updatedness, area of employment, or higher education degree (p > 0.05). A higher score on agreement toward SDF use was accompanied by a greater degree of self-declared updatedness on noninvasive, micro and minimally invasive procedures for caries management in children (rho 0.259; p = 0.031). Pediatric dentists consider themselves updated and agree with the sentences on recommended use of fluoridated toothpaste as of eruption of the first tooth, and on the selective removal of decayed tissue. Disagreement still continues regarding application of SDF to arrest lesion progression, sealing of small dentin lesions, and the Hall technique.

Dyspnoea at the end of life: instrument development and validation-the CONFORTO Strategy.

OBJECTIVE: To describe the construction and validation of the algorithm for Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid (CONFORTO), an instrument to guide health professionals in managing dyspnoea in patients with an advance stage of the disease at the end-of-life. METHODS: The study was carried out in three stages: (1) literature review and construction of CONFORTO; (2) semantic validation; (3) application of the CONFORTO Strategy to health professionals as a test (before video lessons) and post-test (20 days after watching video lessons) methodology. The scores obtained in the pretest and post-test were compared using the Wilcoxon test. RESULTS: Seventy-four professionals from different internal medicine and intensive care units participated in the study. The CONFORTO Strategy involved eight acronym-forming items: Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid. The post-test indicated a significant increase in the score for the following items: facial air flow (p=0.016); oxygen (p=0.002); relaxation and breathing (p=0.002) and treating the causes of dyspnoea (p=0.011). The increase in score occurred after the training sessions with video lessons. CONCLUSION: The CONFORTO Strategy proved valid and reliable for managing dyspnoea in patients with an advanced stage of the disease at the end-of-life. Because the instrument is easy-to-use, it can be used by the entire health team at any assistance-providing location, and can, thus, contribute to improving dyspnoea management for these patients.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems.

The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Evaluating the agreement between children and their parents on dental pain in children using the self-reported method.

BACKGROUND: Having preschool children evaluate their dental pain can provide an additional insight into pain diagnoses and improve patient-centered care. This study aimed to evaluate the agreement between self-reported dental pain by preschoolers and their parents' report (proxy measure). DESIGN: This cross-sectional study was conducted with children aged 4 to 6 years, and with one of their parents. Dental pain was reported using the Simplified Faces Pain Scale (S-FPS) and administered before the dental consultation. Dental pain was assessed using closed-ended questions, and a three-face scale was used to determine pain severity. The kappa and weighted kappa tests were used to evaluate the agreement between the children's self-report and their parents' report. RESULTS: A total of 198 child-parent dyads participated. Current child dental pain was reported by 44.4% of the children and 36.9% of the parents. Severe pain was reported most frequently between children (17.1%) and parents (16.2%). The agreement on the severity of dental pain ranged from substantial (children aged 6 years and parents: weighted kappa = 0.372) to moderate (4-year-olds: 0.412; 5-year-olds: 0.453). CONCLUSION: Children and parents agreed on the child's dental pain. The use of the S-FPS among younger children appears valid and feasible for assessing dental pain.

Minimal intervention procedures: evaluating how much pediatric dentists really know about this field

Abstract The aim of this cross-sectional study was to evaluate how much pediatric dentists know about the noninvasive, micro, and minimally invasive strategies for managing caries lesions in deciduous teeth. An electronic questionnaire was sent to pediatric dentists enrolled in the Regional Board of Dentistry. Information was collected concerning: 1) characteristics of the participants; 2) level of updated knowledge of noninvasive, micro and minimally invasive procedures for caries management in children; 3) agreement to sentences on the indicated procedures. The data were analyzed descriptively and with bivariate tests. Seventy pediatric dentists participated. Results showed high frequency of agreement with sentences on strategies for lesion caries management: 92.8% with the sentence on selective removal of decayed tissue; 90.0% on fluoridated toothpaste (≥1,000 ppm); 84.3% on silver diamine fluoride (SDF); 80.0% on the Hall technique; and 76.9% on the sealing of small dentine lesions. Level of agreement with sentences was not significantly related to variables of time since graduation, degree of updatedness, area of employment, or higher education degree (p > 0.05). A higher score on agreement toward SDF use was accompanied by a greater degree of self-declared updatedness on noninvasive, micro and minimally invasive procedures for caries management in children (rho 0.259; p = 0.031). Pediatric dentists consider themselves updated and agree with the sentences on recommended use of fluoridated toothpaste as of eruption of the first tooth, and on the selective removal of decayed tissue. Disagreement still continues regarding application of SDF to arrest lesion progression, sealing of small dentin lesions, and the Hall technique.

Impact of dental caries on oral health-related quality of life in children with dental behavior management problems

Abstract: The aim of this cross-sectional study was to evaluate the impact of dental caries and sociodemographic factors on the oral health-related quality of life (OHRQoL) of children with dental behavior management problems (DBMP) and their families. One hundred and thirty-four dyads of caregivers and children participated. The impact of OHRQoL was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Socioeconomic variables were obtained from an interview. Dental caries was assessed using the dmft index. The total B-ECOHIS score was categorized as low, medium, or high impact, and its association with the independent variables was determined based on bivariate tests and a multivariate model. The median score for B-ECOHIS was 13 (range: 1-40). The negative impact was reflected mainly by complaints of oral/dental pain, difficulty in eating and parental guilt. The number of teeth with caries was significantly higher among children who experienced a high negative impact on OHRQoL (mean 9.2 [standard deviation 3.5]; p = 0.003) than those who had a low negative impact (7.0 [3.3]). The final adjusted model showed that dental caries remained independently associated with poor OHRQoL (b = 0.100; x2 Wald 4.205; p = 0.040). A greater impact on OHRQoL was experienced by children with DBMP and greater caries experience.

Is dental anxiety associated with the behavior of sedated children?

The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Intranasal Dexmedetomidine Compared to a Combination of Intranasal Dexmedetomidine with Ketamine for Sedation of Children Requiring Dental Treatment: A Randomized Clinical Trial.

Outpatient pediatric sedation is challenging. This study aimed to test intranasal dexmedetomidine efficacy as a single drug or combined with ketamine (DK) to sedate children undergoing dental treatment. Children < 7 years were randomized into dexmedetomidine 2 mcg/kg and ketamine 1 mg/kg (DK) or dexmedetomidine 2.5 mcg/kg (D) groups. Videos from the dental sedation allowed the systematic assessment of children's behavior (primary outcome) according to the Ohio State University Behavioral Rating Scale (OSUBRS). Secondary outcomes were parental and dentist satisfaction, adverse events, and recovery time. The data were analyzed descriptively and through regression models. Participants were 88 children (44 per group; 50 boys). The duration of quiet behavior (OSUBRS) was higher than 50% (DK mean 58.4 [standard deviation 38.1]; D 55.2 [39.1]; p = 0.225). Parents (DK 78.0 [32.2]; D 72.7 [35.1]; p = 0.203) and dentists (KD 62.7 [41.0]; D 62.8 [40.1]; p = 0.339) were overall satisfied. Adverse events occurred in 16 cases (DK n = 10, 62.5%; D n= 6, 37.5%; p = 0.104) and were minor. The median recovery time in the DK group was 1.3 times greater than in group D (p < 0.05). Intranasal sedation with dexmedetomidine alone is equally efficacious and satisfactory for pediatric sedation with fewer adverse events and faster recovery than the DK combination.

Sedation versus protective stabilization for dental treatment of children with caries and challenging behavior at the dentist (CHOOSE): a study protocol for a non-randomized clinical trial.

BACKGROUND: There is a lack of evidence on the effectiveness of moderate sedation in pediatric dentistry, compared to protective stabilization, which remains routinely used in Brazil despite moral questions. This prospective non-randomized clinical trial's objective is to evaluate the effectiveness of moderate sedation, compared to the protective stabilization, in the dental care of children with dental behavior management problems. METHODS: Participants will be 152 children under seven years of age with early childhood caries (ECC) who need specialized dental treatment due to a history of challenging behavior during dental care. The interventions to be compared are moderate sedation with oral administration of ketamine and midazolam and protective stabilization. The primary endpoint will be the child's behavior during treatment assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The secondary outcomes are (A) child's - behavior according to the visual analogue scale, anxiety, pain, and physiological stress; (B) parent's - satisfaction and anxiety; (C) family and child - impact on oral health-related quality of life (OHRQoL); (D) dentist's - satisfaction and stress; (E) procedure - adverse events of the intervention and dental treatment longevity. A cost-effectiveness analysis will be performed from the perspective of the Brazilian Unified Health System (SUS). DISCUSSION: Considering the primary outcome, this study hypothesis is that sedated children have better behavior during dental treatment than children whose behavior was managed by protective stabilization without sedation. Additionally, at the end of 12 months, we expect to identify participants' reported outcomes and objective measures related to dental behavior in early childhood. Trial registration Clinicaltrials.gov registration NCT04119180 on October 8th, 2019. https://clinicaltrials.gov/ct2/show/NCT04119180.

Técnicas básicas para manejo do comportamento infantil no atendimento odontológico: scoping review / Basic techniques for managing child behavior in dental care: scoping review

Introdução: Para tornar o atendimento odontopediátrico mais confortável e reduzir a ansiedade, o dentista pode usar as técnicas básicas e avançadas de manejo do comportamento infantil. Objetivo: Identificar as técnicas básicas de manejo de comportamento investigadas nos últimos dez anos e sintetizar os resultados sobre a eficácia na redução do medo/ansiedade, melhora do comportamento e aceitabilidade. Fontes de dados: Uma busca foi realizada no PubMed, Scielo, Lilacs e Grey Literature Report, em outubro/2021. Estudos observacionais e de intervenção sobre o uso de técnicas básicas de manejo de comportamento no atendimento de crianças com até 6 anos, e publicados nos últimos dez anos, foram incluídos. Síntese dos dados: De um total de 756 referências, 63 foram lidas integralmente e 15 incluídas na scoping review. Distração, reforço positivo, controle de voz, falar-mostrar-fazer, modelagem e presença/ausência dos pais foram investigadas em ensaios clínicos e em estudos transversais. As técnicas foram eficazes na redução da ansiedade odontológica e, a maioria, bem aceita pelos pais/cuidadores. Controle de voz e presença/ausência dos pais foram as menos aceitas. Resultados controversos sobre o efeito no comportamento foram observados nos estudos sobre a presença/ausência dos pais. Conclusões: Distração foi a técnica investigada com maior frequência nos estudos selecionados, seguida por reforço positivo, presença dos pais, controle de voz e falar-mostrar-fazer. As técnicas básicas tiveram resultados positivos na redução da ansiedade infantil e na aceitabilidade dos pais. Controle de voz e presença/ausência dos pais devem ser recomendadas com cautela.

Introduction: To make pediatric dental care more comfortable and reduce anxiety, the dentist can use basic and advanced techniques for managing child behavior. Objective: Identify the basic behavior management techniques investigated in the last ten years and synthesize the results on efficacy in reducing dental fear/anxiety, improving behavior and acceptability. Sources of data: A search was conducted in PubMed, Scielo, Lilacs and Grey Literature Report, in October/2021. Observational and interventional studies on the use of basic behavior management techniques in the care of children up to 6 years old, and published in the last ten years, were included. Synthesis of data: Of a total of 756 references, 63 were read in full and 15 included in the scoping review. Distraction, positive reinforcement, voice control, tell-show-do, modeling, and presence/absence of parents were investigated in clinical trials and cross-sectional studies. The techniques were effective in reducing dental anxiety and, most, well accepted by parents/caregivers. Voice control and presence/absence of parents were the least accepted. Controversial results on the effect on behavior were observed in studies on the presence/absence of parents. Conclusions: Distraction was the most frequently investigated technique in the selected studies, following by positive reinforcement, presence of parents, voice control and tellshow-do. The basic techniques had positive results in reducing childhood anxiety and accepting parents. Voice control and presence/absence of parents should be recommended with caution.

Is dental anxiety associated with the behavior of sedated children?

Abstract The aim of this cross-sectional study was to investigate factors associated with dental anxiety in children treated under moderate sedation. Prior to treatment, each child's dental anxiety was evaluated using the modified Venham Picture Test (VPT). Interviews were also conducted with parents/guardians to gather information on the child's dental anxiety (Corah's Dental Anxiety Scale [DAS]), age and sex, shyness or anxiety in the presence of strangers, and dental history, as well as socioeconomic factors. All the children were sedated, and had at least one tooth restored using the atraumatic restorative treatment technique. Child behavior was assessed using the Frankl scale. Data analysis involved descriptive statistics and bivariate tests. The median VPT score was 2.0 (range: 0 to 8). Children who were shy in the presence of strangers (yes: median 2.0 [0-8]; no: 0.5 [0-4]; p = 0.018), and those with negative behavior during dental care (negative: 3.0 [0-8]; positive: 1.0 [0-8]; p = 0.014) had greater anxiety. The child's dental anxiety was associated with the mother's education level (≤ 8 years: 4 [2-7]; > 8 years: 1 [0-8]; p = 0.016). The dental anxiety of children treated under sedation is associated with negative behavior, shyness, and the mother's education level.

Recommended procedures for the management of early childhood caries lesions - a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE).

BACKGROUND: Early childhood caries (ECC) affects millions of children up to 6 years old. Its treatment positively impacts the quality of life of children and their families. However, there is no consensus on how to treat ECC. Thus, we performed a scoping review to identify the recommended procedures for the management of ECC lesions. METHODS: A search was performed in PubMed, Scopus, The Cochrane Library, The International Guideline Library and pediatric dentistry associations around the world were contacted by email for unpublished search documents. ECC guidelines/guidance/policies were considered eligible regardless of language and publication date. RESULTS: From a total of 828 references, 52 full-text articles were assessed for eligibility and 22 included in the scoping review. We found different procedures recommendations for the management of ECC lesions. For incipient lesions, minimally invasive methods such as professional fluoride and cariostatic (silver diamine) applications, as well as surveillance were recommended. If restoration was required, the recommended materials were glass ionomer cement, composite resin, amalgam and stainless-steel crown. Interim restorations and Atraumatic Restorative Treatment (ART) were also recommended. Extractions have been suggested for teeth with lesions with pulpal involvement, depending on the child's behaviour and other clinical conditions. CONCLUSIONS: Non-operative procedures, restorative and extraction were recommended for the management of ECC, depending on the extent of the lesions. There is no difference between different management guidelines/guidance/policies for ECC lesions.

Dental Pain in Preschool Children Using the Brazilian Dental Discomfort Questionnaire and its Association with Dental Caries and Socioeconomic Factors.

Purpose: To assess the prevalence of dental pain in preschool children through the Brazilian Dental Discomfort Questionnaire (DDQ-B) and its association with dental caries, its severity, and socioeconomic factors. Methods: The study included 485 three- to four-year-olds who attended the National Day of Children's Vaccination in São Paulo, Brazil. Parents answered the DDQ-B and questions of socioeconomic conditions. Calibrated dentists assessed dental caries using the decayed, missing, and filled primary teeth (dmft) index and its severity using the pulpal involvement, ulceration of mucosa due to root fragments, fistula, and abscess (PUFA) index. Poisson regression with robust variance was used with a level of significance of five percent. Results: The prevalence of dental pain was 11.8 percent. Dental pain was associated with a prevalence of dental caries (prevalence ratio [PR] equals 2.47; 95 percent confidence interval [95% CI] equals 1.33 to 4.58; P=0.004) and severe caries (PR equals 2.98; 95% CI equals 1.39 to 6.39; P=0.005). Socioeconomic factors were not associated with dental pain. Conclusions: The prevalence of dental pain in preschool children is relevant when assessed through the Brazilian Dental Discomfort Questionnaire. Dental pain is associated with dental caries prevalence and its severity. Socioeconomic factors were not associated with dental pain.

Developmental enamel defects are associated with early childhood caries: Case-control study.

BACKGROUND: Knowledge on the association between developmental enamel defects (DED) and early childhood caries (ECC) has importance for the drafting of prevention measures and oral healthcare planning. AIM: To compare the frequency of ECC in children with and without DED and verify their association with sociodemographic factors. DESIGN: This case-control study was carried out with Brazilian children aged one to five years. The case group made up of 98 children with ECC and the control group was made up of 98 children without ECC. DED were classified in diffuse opacity, demarcated opacity and enamel hypoplasia (Developmental Defects of Enamel Index). Sociodemographic data were collected by a questionnaire answered by parents. Statistical analysis used McNemar's test and logistic regression analyses. RESULTS: In the bivariate analysis, ECC was more frequent among children from families with poorer socioeconomic conditions (lower monthly household income [P ≤ .001] and lower maternal schooling [P = .001]) and among those with DED (P ≤ .001). The final logistical model showed that children with DED (OR: 1.94) and a monthly household income less than two Brazilian minimum salaries (OR: 2.24) were more likely to have ECC. CONCLUSIONS: The occurrence of DED and lower household income were pre-disposing factors for the occurrence of ECC.

Risk of Dental Caries in Primary Teeth with Developmental Defects of Enamel: A Longitudinal Study with a Multilevel Approach.

The risk of dental caries seems to be greater in the presence of developmental defects of enamel (DDE). The aim was to determine whether the presence of DDE in the primary teeth of preschool children increases the risk of dental caries in the primary dentition after a period of approximately 2 years. This study was conducted in two stages: baseline (T0) and follow-up (T1). At T0, examinations were conducted for the diagnosis of enamel defects using the DDE index (FDI, 1992), dental caries, and oral hygiene. The participants were allocated to two groups according to the presence (affected) or absence (unaffected) of DDE. At the second evaluation (T1), examinations were performed for the diagnosis of dental caries. Poisson regression analysis with a multilevel approach was used to determine the association between DDE and dental caries. The two levels of the analysis were tooth and child. Among the 339 children (113 affected and 226 unaffected) examined at baseline (T0), 325 were re-examined at follow-up (T1). According to the multilevel analysis, teeth with enamel hypoplasia had a greater risk of having dental caries (RR: 1.99; 95% CI: 1.19-3.33). The risk of caries was greater on posterior teeth (RR: 2.59; 95% CI: 2.18-3.07) and maxillary teeth (RR: 1.48; 95% CI: 1.26-1.75) that had DDE at T0. On the child level, dental caries at T1 was associated with having dental caries at T0 (RR: 1.38; 95% CI: 1.32-1.46). In conclusion, enamel hypoplasia and previous dental caries are risk factors for carious lesions in the primary dentition.

Do preschoolers with adverse birth outcomes have more distress during dental examination?

PURPOSE: Studies assessing the influence of neonatal complications on children's dental behaviour are lacking. We aimed to investigate whether prematurity, birth weight, and history of neonatal intensive care unit (NICU) hospitalisation are associated with distress during dental examination in children. METHODS: This preliminary longitudinal, retrospective study included 42 5- and 6-year-old children. Distress during dental examination was assessed using the observational FLACC Pain Assessment Tool through video files. Children self-reported their pain (Faces Pain Scale-Revised) at the end of the session. Information about neonatal complications was obtained through medical records. Bivariate analysis was performed (P < 0.05). RESULTS: Children with low birth weight (P = 0.047) and toothache history (P = 0.005) had higher frequency of distress during dental examination. There was no association between distress, prematurity and history of NICU hospitalisation (P > 0.05). CONCLUSIONS: Health professionals can help to disseminate the knowledge that children with history of low birth weight are more prone to perceive distress with apparently painless procedures.

Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation.

PURPOSE: The optimal sedative regime that provides the greatest comfort and the lowest risk for procedural sedation in young children remains to be determined. The aim of this randomized, blinded, controlled, parallel-design trial was to evaluate the efficacy of intranasal ketamine and midazolam as the main component of the behavioral guidance approach for preschoolers during dental treatment. MATERIALS AND METHODS: Children under seven years of age, with caries and non-cooperative behavior, were randomized into three groups: (KMIN) intranasal ketamine and midazolam; (KMO) oral ketamine and midazolam; or (MO) oral midazolam. The dental sedation appointments were videotaped, and the videos were analyzed using the Ohio State University Behavioral Rating Scale (OSUBRS) to determine the success of the sedation in each group. Intra- and postoperative adverse events were recorded. Data analysis involved descriptive statistics and non-parametric tests (P < 0.05, IBM SPSS). RESULTS: Participants were 84 children (28 per group; 43 boys), with a mean age of 3.1 years (SD 1.2). Children's baseline and the dental sedation session characteristics were balanced among groups. The success of the treatment as assessed by the dichotomous variable 'quiet behavior for at least 60% of the session length' was: KMIN 50.0% (n = 14; OR 2.10, 95% CI 0.71 to 6.30), KMO 46.4% (n = 13; OR 1.80, 95% CI 0.62 to 5.40), MO 32.1% (n = 9) (P = 0.360). Adverse events were minor, occurred in 37 of 84 children (44.0%), and did not differ among groups (P = 0.462). CONCLUSION: All three regimens provided moderate dental sedation with minor adverse events, with marked variability in the behavior of children during dental treatment. The potential benefit of the ketamine-midazolam combination should be further investigated in studies with larger samples. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02447289. Registered on 11 May 2015, named "Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO)."

Developmental defects of enamel in the deciduous incisors of infants born preterm: Prospective cohort.

OBJECTIVE: Developmental defects of enamel (DDE) in preterm infants still require clarification and may favour dental caries, lower food intake and greater difficulty with weight-height gain. We evaluated factors associated with DDE in preterm infants. SUBJECTS AND METHODS: In this prospective cohort study, we monitored 54 prematurely born infants from birth to 24 months of age. Trained and calibrated dentists examined the oral cavity of these children to identify and categorize DDE. Information on perinatal variables was collected from the infants' medical records and interviews with their mothers. The data were analysed using Student's t test, a chi-squared test and Pearson's product-moment correlation coefficient. RESULTS: A total of 46.3% of the 54 children presented DDE, which was observed more frequently in the left hemiarch in children born extremely (<28 weeks of gestation) or very preterm (28 to <32 weeks; RR = 2.2; 95% CI 1.3-3.6), with very low birthweight (<1,500 g; RR = 2.0; 95% CI 1.1-3.5), who were admitted to the neonatal intensive care unit (RR = 1.3; 95% CI 1.0-1.7), and who were intubated (RR = 1.6; 95% CI 1.1-2.2). CONCLUSIONS: The high incidence of incisor enamel defects, particularly on the left side, was related to higher risk prematurity and to local trauma from intubation.